C: "I grew up on an Aberdeen
Angus Beef Farm in upstate New York, and received
my undergraduate degree from Yale University. I
went to medical school at Western Reserve University
in Cleveland Ohio, and my internship and most of
my residency at the Cleveland Clinic, a portion of
that at St. George's Hospital in London, England. After
I finished my training, I had two years in the Army,
the first year at Fort Bragg, North Carolina, and
the second year trying to help clean up the carnage
in Vietnam. Then I came back to Cleveland and
was asked to join the staff of the Clinic in the
Department of Surgery."

M: "Your
father died of heart disease in 1975. Did
this have any impact on your research?"

C: "My father had his first
heart attack when he was 43 and went on to develop
atrial fibrillation through the years, came down
with diabetes in his sixties. Then he developed
a cancer of the prostrate, and it was while he was
dying of cancer that he had his last heart attack. Although
he was a great big strong fellow who played football
at Yale, he really was sort of a badly living fossil
from the ravages of of Western nutrition. Between
the combination of a heart attack in his early forties,
prostrate cancer and diabetes, it doesn't get much
worse than that. Whether that influenced me
or not, I don't really know. I did general
surgery and at some level, maybe subliminally, maybe
there was this desire to get to the "roots" of
this family illness."

M: "It's kind of ironic that this is "National Heart
Month," and I think that you're probably the person best qualified to
summarize the current situation in the U.S. regarding Heart Disease right
now."

C: "My own feeling is that
if you were to summarize where we stand on this epidemic,
we have a great many brilliant minds that are focussed
on mechanisms, drugs, and procedures, and we've have
sort of abandoned the capacity of the public to take
care of this epidemic on their own. I would
like to say right now that perhaps there can be no
greater condemnation of 21st Century medicine then
its refusal to share with the public the causation
and cure of its most frightening chronic illnesses. How
in the world can we have someone who's had two or
three heart attacks and a couple of bypasses, and
not say to them --- look them in the eye and say "Look. I'm
tired of doing these bypasses for you. Why
don't you cure yourself? I mean, it's not that
these people can't do it, it's just that they don't
have the information available. It's extremely
difficult to in any way applaud what medicine is
doing in this arena because the public just isn't
being told what they can do to cure themselves. To
paraphrase John Kennedy: "Ask not what you country
can do for your health, ask what YOU can do for your
health."

M: "This more or less begs
the question: is this calculated?"

C: "Oh, I don't think that
this is the case. It's that the mentality of
medicine is such that if there's a blockage we can
bypass it, if there's a blockage, we can open it
up. But what there's not, is any sound appreciation
that the metabolic derangement of the human organism
is so grave from eating this Western diet, that it
ends up creating all these metabolic disturbances. And
somehow the mentality of medicine is that they cannot
really accept the idea that someone's own metabolism
is much wiser, much more brilliant, safer, and less
expensive in resolving this epidemic than we with
our tools and our drugs. The truth of the matter
is that nothing is a strong and as capable as the
anatomy and metabolism of the patient's ability to
restore themselves, and it's a very very hard sell,
as somewhere in there, we see this ugly equation
of finances."

M: "When you call heart disease an epidemic, you're not
mincing words. What are the numbers?"

C: "Well, right now we're
having close to a million people die of cardiovascular
disease every year, and 500,000 dying of heart attacks. For
many people [1 out of 4] the first manifestation
of the disease is that they suddenly find themselves
dead. When you think about the attempt to treat this
with, let's say, stents --- stents have a mortality
that is accepted at 1%, but 1% of a million stents,
which is the number that are done per year in this
country, adds up to about 10,000 people that are
dying. Now if you had 10,000 U.S. soldiers
dying in Iraq this year, that would really be called
carnage. It's very difficult, because this
has been going on so very long --- we sort of accept
this epidemic. It's a huge tragedy --- yet
back at the turn of the century in 1895, 1900, Sir
William Osler said in one of his writings that he'd "never
seen a case of angina pectoris."

C: "What typically happens
is that the patient develops symptoms of heart disease,
usually chest pain or a shortness of breath, and
in the course of being investigated one of the things
they'll have is a stress test, and if they fail the
stress test, then that's sort of an automatic entry
into the catheterization laboratory, where you will
find the blockage. Now literally, practically
all Americans over the age of 55 are going to have
some blockage, because if 80% of us have this disease
as 20-year olds, certainly most will in their 50's
and 60's. As a matter of fact, Dr. Lewis Kuller,
who is a Professor of Medicine at the University
of Pittsburgh School of Medicine has said the following
[from conclusions of a 10-yr. study]: "All
males 65 years of age and older who have been exposed
to the traditional Western diet, have cardiovascular
disease and should be treated as such." How
powerful is that? What kind of statements is
that about the kinds of food that we're eating? Fortunately,
as hideous as it is that we have this disease which
is epidemic throughout the population in this country,
we also have this wonderful information that there
are many cultures that are plant-based, where this
disease is virtually non-existent. And if we
really get our act together, we can change our basic
nutritional formulae to be plant-based, avoiding
the oils, the dairy, and the meat that are causing
this disease. Cardiovascular disease is just
one of the tragedies, I didn't mention diabetes,
hypertension, strokes, and obesity... gallstones,
diverticulitis, and on it goes."

M: "The typical bypass procedure
and angioplasty, could you summarize what they're
like?

C: "Once the patient has
a blockage identified on the angiogram they will
usually follow that up with a fine balloon that is
inserted and deflated into the area of narrowing
of the artery. Let's say an artery is 90% blocked,
they'll then inflate the balloon, and it does actually
what we call a "fracture." It doesn't just
push the plaque up against the wall of the artery,
it fractures the tissue layers of the artery. After
the angioplasty, they found that just after six months,
the healing process was so over-done trying to heal
that fracture, for over 50% of the people who have
their blockage, it was now closed again."

M: "Aw, no..."

C: "...so that wasn't such
a great track record. Then they said, let's
put in sort of a "wire bracket" that is,
after we dilate it, we'll hold it open with this
sort of metal scaffolding. That was better,
because only about 15 to 25% of those would close
down after six months. But that still wasn't
good enough. So then the idea was to put a
coating of drug on the wire stent, and the drug would
be gradually eluting, that is to say it would gradually
dissolve off the wire cage and it was extremely inhibitory
to the natural healing response of the artery."

C: "And that was actually
quite exciting, because now only about 5 or 10% would
be narrowing. But recently, there's been a
very worrisome finding, and that is when you stop
the anti-clotting drug, which is necessary after
all these stents, when you stop that after six months
to a year in these drug-eluting stents, there's a
disturbing number of persons who will suddenly have
a clot in that area of the stent and you have a heart
attack or die. One of the reasons that has
been put forth as to why that happens is that in
all patients who have the angioplasty, it seems to
wipe away the delicate single layer of cells called
the endothelial cells that actually line the inside
of the artery. When those cells are present
your blood is flowing through the artery like it's
with teflon, but when those cells are wiped away
it's like velcro. The blood would clot there
unless they were taking this anti-clotting drug.

So
now the situation is a bit of a bind, because anybody
who now with the drug-eluting stents is going to
take the anti-clotting drug for an indefinite period,
maybe for the rest of their lives. But this
a a problem, not only because it's expensive ($1600
a year), it leads to bruising, gastral-intestinal
hemorrhaging in some situations, and less frequently
even cerebral hemorrhaging. And let's suppose
a patient who has had a successful stent is taking
this anti-clotting drug now has to have hip surgery,
or oral surgery, or colonoscopy... they have to stop
taking the anti-clotting drug, with a great concern
and a great fear that if they stop, they may clot
their stent and have a heart attack or die, and that
has happened. So... the approach, as you
can see with all this manipulation, is not great.

If you have a bypass operation there is a higher mortality
rate then with a stent. It's an bigger procedure
as they have to saw the chest in half and then widen
it so you can take veins from your leg and place
them on the heart to bypass the blockage. Now
the problem here is that the veins that are used
were absolutely never intended to be in the arterial
system. So literally with every beat of the
heart, there's a much higher pressure that these
veins are now subjected to and there's injury, and
that repeated injury leads to scarring and fibrosis,
so that the veins lock again and obstruct blood flow. That
was one of the great problems with bypass surgery,
that the stents often would go down, and they either
had to have a repeat surgery, or something else. They
did try bypasses with arteries, and that seems to
be better. But not everybody has the right
anatomy to have that kind of bypass, and in addition,
there are often not enough arteries to go around,
so they end up using veins anyway.

One of the bigger problems that is rarely discussed,
with bypass surgery, is that there's a vein that
goes to the brain when you clamp the aorta, when
you're on the membrane-oxygenator and plastic, some
minute debris from the equipment and even oxygen
bubbles may sadly end up in the brain, so that it's
well-recognized that the patients who have bypass
surgery will often have temporary confusion, and
maybe frank encephalopathy, it's harder for them
to hold a job. When it's carefully measured
and recorded in a scientific study as reported in
the New England Journal of February 2001, there really
is about 50% of the people having permanently a loss
of upwards of 22% of their cognition. This,
sadly, is not brought up or discussed often with
the patient. This is something that seems to "slide
by."

M: "You've clearly established that this is a serious
epidemic and that so-called modern methods of dealing with it are horrendous
and riskier than most people believe. In the Forward to your book,
Dr. T. Colin Campbell says that you are suggesting a paradigm shift in how
we treat coronary artery disease. Can you discuss how you came to these
conclusions?"

C: "What I was involved
with is something that was ridiculously simple: when
one looks at the epidemiology of heart disease, and
you see that it doesn't exist in cultures where they
live primarily on plant-based nutrition, and they
have a cholesterol of a range, let's say, of 90 to
150, as in the rural Chinese, it just begs the opportunity
to take patients who are seriously ill with coronary
disease and have them eat this plant-based nutrition
and see if we can't absolutely halt the disease,
or perhaps even reverse it."

M: "Howard has suggested
that this was a very audacious thing to believe you
can do."

C: "Well, you're absolutely
correct. It was audacious because back in 1985,
when we started, and others started who actually
accomplished it before I did, nobody had ever really
reversed the disease, but on the other hand, nobody
had ever tried it. And the idea was to, at
least as far as I was concerned, was to try and eliminate
what we thought were the atheroma sclerotic foods,
that is to say all the oils, the dairy, the meat,
the fish, the poultry, and the white flour and the
processed food. This is exactly what happened
with the research --- I went to cardiology and they
were going to get me 24 patients who had advanced
coronary artery disease."

M: "I think you referred to them as the "walking
dead men" in your book?"

C: "Well, they either had
failed their first or second bypass, or they failed
their first or second angioplasty, or they were too
sick for these procedures or they had refused them
and there were a number of these people who literally
could not take any more doses of the anti-angina
medication --- they were very sick, and a number
were told that they would not survive beyond a year. So,
the rock upon which this study was most likely to
flounder was lack of patient compliance. I
think the way that I thought we could get an upper
hand on that was to use the same mantra that I use
with my cancer patients, which I learned years
ago from a West Coast surgeon, which is that was
patients with cancer are not afraid to suffer, not
afraid to die, but they are afraid to be abandoned
by their physician and their family, and so for the
first five years of the study I saw every patient
myself every two weeks, went over every morsel they
ate, checked their lipid profile plus their blood
pressure and pulse. Then for the next five
years I saw them every four weeks, and in the last
two years quarterly and by then, they were pretty
well on their own --- on autopilot. I also
checked them all again at the time of the beginning
of the writing of the book, 21 years later."

So, several things we did learn from this. One
is that patients WILL comply, when you explain to
them exactly what the mechanisms of the disease are,
and how we want to go about treating it --- when
you give them the time, and the care and the support,
they are more than delighted to do it. What
the cardiology community and most physicians will
say is that the patients just won't follow the recommendations. Well,
they won't follow it if you just hang a piece of
paper and say "these are the guidelines." This
has got to have the same degree of importance as
a three-hour bypass operation. Then I think
you'll really get things done. Another thing
I think has to happen is that physician's have to
be willing to say to a patient: "look,
this is absolutely the way to go. This is going
to cure you. I'm tired of giving you these
procedures. You can do this." The
exciting thing, at least for my patients, is that
they are the locus of control. Not the cardiologist
or the cardiac surgeon. They themselves become
the locus of control for this disease. You
just show them how to do it, and they can get it
done."

M : "In your book you call your results and conclusions "irrefutable." Hearing
that from a scientist of your considerable reputation and experience, that's
a very strong statement. Do you think your sample size was a bit small,
even considering that your study is the longest of it's kind yet accomplished?"

C: "I think that's an excellent
question, as it's something that people will bring
up --- it's sort of fashionable when you're questioning
studies that one of the first things you might say, "the
sample size is too small." I think actually,
believe it or not, that it's one of the strengths
of study and I'll explain why. When the study
was started, in 1985, I first went to the head of
our research division, who at that time, was Dr.
Bernadine Healy. She went on later to be head
of the National Institutes of Health [and president/CEO
of the American Red Cross]. Bernadine Healy
told me at that time, "look, nobody has ever
reversed this disease, but if you just have four
patients with reversal on their angiogram, you have
a New England Journal of Medicine article." I
had a total of 24 patients.

The other point about have a study this size is that
despite the fact that I was still obligated to do
my surgical duties, having a half day off every week
for research allowed me to see these patients on
a regular basis to give them the kind of support
that was absolutely necessary in a behavior modification
study that would achieve the kind of compliance that
is essential to get these results. If you try
to do this one person with a thousand patients, it
would be impossible. The exciting thing is
this: we were able to show, as were four or
five others of the same time frame, that indeed the
disease could be arrested and reversed. Let's
suppose you have a disease that never before has
been arrested or reversed. Then you have several
investigators throughout the country, within five
or six years, finding the same thing. Really,
this disease is kind of a paper tiger. Chronic
heart disease is not inevitably progressive, like
cancer, this is something that really can be changed,
can be changed drastically when you make significant
changes in the nutritional profile."

M: "I think another advantage
of the size was that you were able to quickly identify
minute changes in cholesterol levels from people
straying from the program."

C: "Absolutely. We
were running a lipid profile every two weeks to get
at cholesterol. So suddenly we go "whoops!" we
got to go over this, we have to tighten up and see
what's going on here."

M: "Sounds like the "red
alert" on the Starship Enterprise. You
could tell immediately when there was a "cause
and effect" thing going on."

M: "Your research reminds me Dr. Dean Ornish's efforts. Was
his work independent of yours, did you influence each other?"

C: "We started totally independently. As
a matter of fact, one of my patients, in 1987, brought
in a Discovery magazine with a picture of some of
Dr. Ornish's patients in his program. I called
him, then went out and visited with him for a weekend. I
just wanted to see what somebody else was doing. They
were doing it differently in that he was very solidly
attracted to the idea of using meditation and relaxation. We
did not have that in our program. He had some
very strong structured exercises as part of the program. I
encourage our patients to exercise, and I do not
have it as a requirement. I feel very strongly
that each of us has within us just so many behavioral
modification units. If you ask patients to
do too many things, something's gonna go. I
wanted them to understand that the most important
thing, as far as I was concerned, is how they ate. That
was the key. I did not feel from my epidemological
review, that those nations where the disease was
non-existent was because they were heavily involved
with meditation or relaxation and structured exercise,
but it was because, by culture, heritage, and tradition,
they were just not eating any of the atheroma sclerotic
foods.

But, let me say by the way, that I think
meditation and relaxation are wonderful... I think
that exercise is fully appropriate and stupendous. I
had a couple of patients that had strokes, in addition
to their severe heart disease, and here they are
now, 21 years later, just kicking up their heels
and doing fine. They were not precluded from
enjoying the benefits of this approach, despite the
fact that they were not able to exercise nor did
they meditate."